Democrats Fear Medicare-For-All Plan Could Sharpen Party Divisions

When Congress returns to Washington next month, Vermont Senator Bernie Sanders will introduce a bill creating a single-payer government-run health care system. He calls it Medicare for All. More and more progressive voters want the Democratic Party to fully embrace the idea. As NPR's Scott Detrow reports, party leaders are wary of doing that.

SCOTT DETROW, BYLINE: Bernie Sanders has been ready to introduce his single-payer bill all year. He's just been waiting for Republicans to finish their effort to repeal and replace the Affordable Care Act, which means Sanders has been waiting for a while.

BERNIE SANDERS: Look, I have no illusions that under a Republican Senate and a very right-wing Republican House and an extremely right-wing president of the United States that suddenly we're going to see a Medicare-for-all, single-payer passed. You're not going to see it. That's obvious.

DETROW: The point of the bill, Sanders says, is to force a conversation.

SANDERS: Excuse me, why is the United States the only major country on earth not to guarantee health care to all people? Why are we spending far, far more per capita on health care than any other nation? Why do we pay the highest prices in the world for prescription drugs?

DETROW: The bill will likely force a conversation within the Democratic Party, too, a party Sanders now acts as a leader of despite not being a member. Polls do show more and more voters like the idea of government-run health care. But top Democrats are keeping it at arm's length. DNC Chairman Tom Perez typically pivots to this broader answer when he's asked whether he would push for single payer.

(SOUNDBITE OF ARCHIVED RECORDING)

TOM PEREZ: We believe that health care is a right for all and not a privilege for a few. And right now in Washington, D.C., in the political climate in which we live, preserving the Affordable Care Act is a major victory.

DETROW: House Minority Leader Nancy Pelosi is more direct.

(SOUNDBITE OF ARCHIVED RECORDING)

NANCY PELOSI: The comfort level with a broader base of the American people is not there yet. Doesn't mean it couldn't be. States are a good place to start.

DETROW: The resistance is tactical, not ideological. It took decades to pass something like Obamacare. And the fear is that despite what polls might suggest, something as aggressive as single-payer just isn't politically feasible right now. In fact, the congressional leaders you hear talking about single-payer are often Republicans, not Democrats. House Speaker Paul Ryan and other Republicans regularly float it as a worst-case Democratic alternative.

(SOUNDBITE OF ARCHIVED RECORDING)

PAUL RYAN: Ultimately, it's very clear that they're more interested in a single-payer system, which means government-run health care. Government-run health care is not in our nation's interest.

DETROW: Senate Republicans even forced a vote on a single-payer option on the Senate floor last month, hoping to get Democrats on record supporting the idea. Most Democratic senators voted present. No one voted yes. Still, more than half of the House Democrats sponsored a separate single-payer bill this year. A longtime aide to Bernie Sanders, Jeff Weaver, argues the broad public opposition to the Republican Obamacare repeal should spur Democrats to become more aggressive on health care.

JEFF WEAVER: This is a very powerful issue in that people are prepared to be mobilized in support of their health care.

DETROW: Like Sanders admits, this bill isn't going anywhere anytime soon. The whole thing is more about political framing, getting Democrats to the point where this would be a top priority whenever the day comes where the party is back in power. Scott Detrow, NPR News.